What happened to Daniel Brett is the worst-case scenario.
After constant, excruciating headaches that stemmed from multiple concussions and months of unsuccessful treatment, the 16-year-old chose suicide as the way to free himself from the pain.
In the year since his death, Diana Brett of Davie has been on a crusade to make her son something other than a statistic. She wants him to be the poster boy whose story will educate parents and young athletes about the dangers of hidden concussions.
Today, Daniel Brett's brain tissue is in the hands of doctors in Boston who are studying the effects of repeated head trauma on athletes.
As Diana Brett waits for their findings, she occasionally finds herself lingering on the website for the Sports Legacy Institute, which includes a page filled with the names and stories of other donor athletes who have been part of the research.
NFL professionals such as former Tampa Bay Buccaneers lineman Tom McHale and former Chicago Bears safety Dave Duerson are profiled. But Daniel Brett's name stands out.
He is the youngest football player being studied, and if doctors find Brett had chronic traumatic encephalopathy (CTE), a degenerative brain disease that can lead to dementia, he will make history.
"It will be huge [if he is diagnosed]," said Dr. Robert Cantu, one of the co-directors of the Center for the Study of Chronic Trauamatic Encephalopathy at the Boston University School of Medicine. "He will have been by far and away the youngest individual with CTE documented, and if that's the case, it will be hugely supportive to the stance I've already taken that youngsters should not be [subjecting] themselves to unneccessary head trauma."
Diana Brett doesn't know if her son had CTE, but she is certain of two things: her son had multiple concussions, and most of them came while he played youth football.
She doesn't regret that her son played the sport. Instead, she smiles when recounting how much he loved football and how he dreamed of playing for the Miami Hurricanes.
She just wants to make sure no other young athlete, football player or not, experiences what her son endured.
"This is my son, my firstborn," she said. "My family has decided we needed to do something to get the message out to the kids that you can't hide your concussions, so that no parent goes through what we did."
A mother's crusade
Daniel Brett began playing football at age 11 with the Sunrise Gators, a youth-league team. A tough player determined to impress coaches, Brett often hid the fact football left him hurting.
Diana Brett says her son's doctors estimated that Daniel suffered as many as 14 concussions in his short career. In March 2011, in an effort to treat those injuries, the Bretts learned about the concussion program at the University of Miami medical school. For a brief period, Daniel's pain subsided.
But the help came too late. When Diana Brett told his doctors about her son's suicide, they weren't surprised.
"You see these kids that suffer for longer periods of time," said Dr. Gillian Hotz, the director of the concussion program at UHealth sports medicine at the University of Miami and one of Daniel's doctors. "They see physicians that aren't trained in concussion management. They'll treat the dizziness, but his [case] became more psychological.
"He was depressed, he went on a downward spiral and one thing compounded with another. It's not that pediatricians and neurologists aren't well trained. They absolutely are. But when it comes to managing concussions, you really have to see them and smell them."
After Daniel's death, Diana Brett started the Daniel Brett Foundation and reached out to other families facing similar struggles. She spoke with Gil Trenum, the father of Austin Trenum, a 17-year-old football player from Virginia who hung himself two days after suffering a concussion.
Trenum, a member of the Prince William County School Board, even provided her with a copy of his district's concussion policy. It was one of the policies she shared with the Broward County School Board when she spoke to school officials about the importance of baseline concussion testing.
In March, Broward County schools adopted that testing for all high school athletes and in April, Brett met with athletic directors and coaches to share her family's story.
"We know it's important to try and provide a higher level of safety to our kids, and she was able to personalize the whole story," said Damian Huttenhoff, Broward's director of athletics and activities. "The important part of what she does is that she tells the kids that they themselves have a role in reporting concussions."
Also in March, the Florida Legislature unanimously passed Senate Bill 256, which authorizes the Florida High School Athletic Association and youth-league coaches associations to create rules for removing student athletes from competition when a concussion happens. It also requires that students return to play only after clearance by a doctor. The bill, sponsored by State Sen. Anitere Flores, R-Miami, was signed by Gov. Rick Scott in April and goes into effect July 1.
The Daniel Brett Foundation supported the law, and Diana Brett joined forces with Cheryl and Adam Goldstein to help get the bill passed.
For the Goldsteins, concussion awareness is also a personal topic; their son, David, a junior at Miami's Ransom Everglades, suffered a concussion two years ago while playing soccer.
"It really is about the kids and their health," said Cheryl Goldstein, whose family worked with a brain injury task force, spoke to legislators and even hired a lobbyist to help the bill pass. "The dangers of a second impact to the head are so incredibly serious that we felt that the student athletes of Florida needed to be protected as they are in many other states across the nation."
To try and raise awareness, Brett also put together a charity race in March that included more than 400 participants. But her biggest targets, she says, are the students playing sports.
Some of them — especially those at West Broward High where Daniel attended classes before his death — are listening.
"You have to tell the coach, every time," said Ian Crosbie, a longtime friend of Daniel's and a football player at West Broward who suffered a concussion last season. "As much as you want to play the game, you have to think of yourself and your future, your family and your friends. You can't hold it in."
On Aug. 24, 2009, his first day of high school, Daniel Brett finally told his football coaches something was wrong.
During his first day of practice with the Cypress Bay junior varsity, he took a hit that left him dizzy and unable to see. Coaches urged Diana to take her son to the doctor.
The next morning, the family's pediatrician ordered an MRI and Daniel eventually confessed to his family that he'd been hiding headaches.
"[Daniel] was a kid that had headaches for a long time. He just didn't say anything," Hotz said. "He took a lot of hits and he'd do extra drills. He was a tough kid."
He never again played football. Instead, Daniel endured 20 months of treatment that included multiple hospital stays, countless visits with neurologists and other specialists, and a host of tests.
He was diagnosed with post-concussion syndrome, a condition in which concussion symptoms like headaches or dizziness last for weeks or even months.
Migraine headaches became part of his daily life and the pain was excruciating. Daniel had trouble concentrating. He sometimes struggled to carry on conversations. He became depressed.
For nearly two years, doctors tried to treat the pain. His medications, which included anti-depressants, weren't helping.
So on a Friday night last May, according to police, Brett drank some beer, gained access to a relative's gun collection, and took his own life with a single shot to the head.
His death added to the statistics. Suicide is the third-leading cause of death for young people between the ages of 10 and 24, accounting for about 4,400 fatalities each year, according to the Centers for Disease Control and Prevention.
Concussion and suicide link
Studies about brain injuries and suicide are ongoing.
A 2007 study published in the journal Brain Injury concluded that people with traumatic brain injuries have a 3-4 times greater risk of death by suicide compared to the general population. That link became a topic of conversation in April when former Atlanta Falcons defensive back Ray Easterling killed himself after years of depression and insomnia that stemmed from multiple head injuries.
The suicide of former Miami Dolphins linebacker Junior Seau in early May fueled the discussion again.
Concussions can be especially dangerous for children and teens whose brains are still developing. The CDC estimates that more than 135,000 children between the ages of 5 and 18 are treated in emergency rooms each year for concussions as a result of participating in sports. More than 60,000 of those are under 14.
"The brain is more vulnerable because it's not developed," Cantu said. "The head of a youngster is also disproportionately larger and the neck is weaker. There are structural and developmental issues."
Pushing Diana Brett to learn and educate others about the effects of youth concussions are the memories from the nightmarish moments after Daniel's death.
The phone call she feared could one day come. The gut-wrenching moment she had to break the news to her then 13-year-old daughter, Marissa, that Daniel was gone. As condolence messages began to appear on Facebook, the heart-breaking realization that she had to get to her 81-year-old father to deliver the news in person before he went online the morning after Daniel's death.
And the moment Brett knows she can never forget — the long, lonely drive to a police department from her Davie home to the Palm Beach Gardens police department where she made the unusual request that her son's brain tissue be preserved.
"The police officer looked at me and said, 'Mrs. Brett, you're in shock,'" she said quietly. "And I said, 'Yes, I am. But I'm not kidding.'"
In her grief, Diana Brett wanted something positive to come from Daniel's death, and she was determined to get him, in any way she could, to another set of doctors that might be able to explain what had happened.
Now, Diana Brett's wait continues. Research on the brains of donor athletes at Boston University's Center for the Study of Chronic Traumatic Encephalopathy usually takes about a year.
The center has studied the brains of a number of athletes including Duerson, who killed himself Feb. 17, 2011, and left a handwritten note that read, "Please, see that my brain is given to the NFL's brain bank." Doctors eventually concluded that Duerson had CTE.
Whether she learns her son had the same disease or not, Diana Brett is determined to continue educating young athletes and their families.
"I have knowledge that I never wanted in my life," she said. "I need to make sure other moms and dads have knowledge should their kids ever get hurt."
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